• Russell B Hawkins, Shauna M Levy, Casey E Senter, Jane Y Zhao, Kaitlin Doody, Lillian S Kao, Kevin P Lally, and KuoJen Tsao.
• Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX, USA; The Children's Memorial Hermann Hospital, Houston, TX, USA.
• Am. J. Surg. 2013 Oct 1;206(4):451-6.

BackgroundDespite increased compliance with Surgical Care Improvement Project infection measures, surgical-site infections are not decreasing. The aim of this study was to test the hypothesis that documented compliance with antibiotic prophylaxis guidelines on a pediatric surgery service does not reflect implementation fidelity or adherence to guidelines as intended.MethodsA 7-week observational study of elective pediatric surgical cases was conducted. Adherence was evaluated for appropriate administration, type, timing, weight-based dosing, and redosing of antibiotics.ResultsProphylactic antibiotics were administered appropriately in 141 of 143 cases (99%). Of 100 cases (70%) in which antibiotic prophylaxis was indicated, compliance was documented in 100% cases in the electronic medical record, but only 48% of cases adhered to all 5 guidelines. Lack of adherence was due primarily to dosing or timing errors.ConclusionsLack of implementation fidelity in antibiotic prophylaxis guidelines may partly explain the lack of expected reduction in surgical-site infections. Future studies of Surgical Care Improvement Project effectiveness should measure adherence and implementation fidelity rather than just documented compliance.Copyright © 2013 Elsevier Inc. All rights reserved.

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